title: Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium.
abstract: BACKGROUND
  Upgrade rates of high-risk breast lesions after screening mammography were examined.
  
  
  METHODS
  The Breast Cancer Surveillance Consortium registry was used to identify all Breast Imaging Reporting and Data System category 4 assessments followed by needle biopsies with high-risk lesions. Follow-up was performed for all women.
  
  
  RESULTS
  High-risk lesions were found in 957 needle biopsies, with excision documented in 53%. Most (n = 685) were atypical ductal hyperplasia (ADH), 173 were lobular neoplasia, and 99 were papillary lesions. Upgrade to cancer varied with type of lesion (18% in ADH, 10% in lobular neoplasia, and 2% in papillary lesions). In premenopausal women with ADH, upgrade was associated with family history. Cancers associated with ADH were mostly (82%) ductal carcinoma in situ, and those associated with lobular neoplasia were mostly (56%) invasive. During a further 2 years of follow-up, cancer was documented in 1% of women with follow-up surgery and in 3% with no surgery.
  
  
  CONCLUSIONS
  Despite low rates of surgery, low rates of cancer were documented during follow-up. Benign papillary lesions diagnosed on Breast Imaging Reporting and Data System category 4 mammograms among asymptomatic women do not justify surgical excision.
authors.affiliation: Department of Surgery, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239 Tel Aviv, Israel. Electronic address: tehillahm@lvmc.gov.il.
authors.forename: Tehillah S
authors.initials: TS
authors.lastname: Menes
authors.affiliation: Radiology Associates of Albuquerque, Albuquerque, NM, USA; Department of Radiology, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenberg
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Balch
authors.affiliation: Department of Pathology, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Jaffer
authors.affiliation: Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA; Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards / Q000639:trends; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging; D016015:Logistic Models; D008327:Mammography; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging
keywords: Atypical ductal hyperplasia; Atypical lobular hyperplasia; High-risk breast lesions; Lobular neoplasia; Papillary lesions; Upgrade